Perhaps one of the most important advances in surgery over the last few decades has been the adoption and routine performance of a variety of minimally invasive procedures. Examples of minimally invasive procedures include angioplasty, endoscopy, laparoscopy, arthroscopy and the like. Minimally invasive surgical procedures such as these can be distinguished from conventional open surgical procedures in that access to a site of concern within a patient is achieved through a relatively small incision, into which a tubular device (or tubular portion of a device) is inserted or introduced. The tubular device or device portion (hereinafter, “the tube”) keeps the incision open while permitting access to the surgical site via the interior (lumen) of the tube.
The tube can be configured for surgical use itself or can be incorporated into a device which also includes other apparatus having surgical utility. One example of the former is in a balloon catheter, in which the tube is configured (particularly shaped and adapted) as a catheter shaft carrying on it an inflatable balloon. Balloon catheters are useful for performing angioplasty and for the deployment of a stent for preventing stenosis (closure) of a body passage, e.g., a blood vessel. Another example of the former is in a diagnostic, infusion or drainage catheter, in which the tube is configured as a catheter for the delivery of a diagnostic fluid to the patient (for example, for imaging); for the delivery of a therapeutic fluid to the patient (either short or long term); or for the removal of a fluid from the patient. Examples of devices including apparatus in addition to the tube are endoscopes, laparoscopes, arthroscopes or the like, and guide catheters and introducer sheaths (percutaneous or otherwise), through which a guide wire or other surgical device is introduced into the patient.
A variety of tube structures are known to be useful for these purposes. Each of such structures has its own advantages and drawbacks. For example, a balloon catheter is often used in an angioplasty procedure for widening a narrowed site in a blood vessel in a patient. Such a procedure entails advancing the balloon catheter through the tortuous vessels of the vascular system to the narrowed site. During such a procedure, the catheter is torqued, pushed and pulled until the appropriate position is achieved. Further, when the balloon catheter is a single lumen balloon catheter, it may include an occluder within its lumen; the occluder is advanced in the balloon catheter and urged against a valve seat in the distal end of the balloon catheter to seal the catheter and permit inflation of its balloon by introduction of a suitable inflation fluid. Thus, the balloon catheter is also subject during use to a force tending to elongate it, making it particularly subject to undesirable “necking,” that is, an undesirable reduction in its outer and/or inner diameter. Of course, necking can arise in other catheter structures and can arise from other causes.
More particularly, to enhance torquability and pushability, some catheters have included a braid in the wall of the shaft of the catheters. Unfortunately, braided catheters are still relatively susceptible to kinking during use. Once a catheter has kinked, fluid cannot pass through the lumen of its shaft. In balloon catheters, this prevents inflation of the catheter balloon. (In other catheters, such as diagnostic, infusion and drainage catheters, prevention of fluid flow similarly interferes with their satisfactory use.) As a result, the balloon catheter must be removed and another catheter introduced into the patient and once again advanced through the vascular system to the narrowed site. This wastes time and increases the potential for trauma to the patient. To prevent kinking, some catheters include a coil in the wall of their shaft, rather than a braid. However, catheters having an embedded coil are undesirably susceptible to necking.
Other medical devices are known which combine a braid and a coil in the wall of a tube incorporated in the devices. For example, a prosthetic blood conduit is known for providing an arterial graft in a patient. The device has a helical reinforcing spring and inner and outer polyester fabric tubes. A variety of known endoscope sheaths have a braid and a coil in the sheath wall, the sheath serving to surround and protect the endoscope itself from bodily fluids during use. One known endoscope sheath is a flexible shaft including a tapered, helical member surrounded by a woven mesh; the mesh and member are purported to give the sheath torsional stability. Another known endoscope tube includes a metallic tubular spiral for resisting collapse and a meshwork tube positioned over the spiral for restricting its longitudinal stretching. Yet another known flexible endoscope tube includes a metal spiral and a fibrous braid fitted over the spiral for elasticity, and for providing the tube with a restoring force that is unhampered by high-polymer materials. Still yet another flexible endoscope tube has two helical coils surrounded by a braid tube, such that the tube will not contract axially during use.
Many of these endoscope tubes share a feature in common: they employ the braid to maintain the coil in a radially compressed condition. Devices other than endoscope tubes are known in which the coil is maintained in a radially expanded condition, for example, the flexible and kink-resistant introducer sheath for percutaneous access disclosed in U.S. Pat. No. 5,700,253 (Fred T. Parker, Dec. 23, 1997) and U.S. Pat. No. 5,380,304 (Fred T. Parker, Jan. 10, 1995), each assigned to Cook Incorporated, Bloomington, Ind. One sheath disclosed in these patents includes a coil positioned between inner and outer tubes. The coil has a diameter less than the outer diameter of the inner tube, the coil being radially expanded and wrapped around an inner tube. The outer tube is then connected to the inner tube through the spaces between the turns of the coil. The patents appear to contain no suggestion to modify the disclosed sheath to further include a braid between the outer tube and the coil. Indeed, it might well be expected that providing such a braid would interfere with the desired connection of the outer tube to the inner tube, defeating the express and intended purpose of the patents.
Many of the other devices disclosed above can be subject to further drawbacks. The successful construction of devices in micro-sizes, having an outer diameter of no more than about 1 or 2 mm, can be problematic. Uniformity of inner and outer diameter along the length of such devices, and uniformity of inner and outer diameter between nominally identical devices, can be difficult to achieve. Moreover, tubes of conventional construction often experience reduced utility if manufactured near such small sizes even if they can be constructed at all. In general, the resulting devices in such small sizes readily collapse, neck and kink during use, and possess poor pushability, poor trackability and poor torquability. Many prior devices do not allow access to sites as deep in the patient than might be desired, or do not allow treatment of structures within the patient as small as might be desired, for example, blood vessels having a diameter on the order of 1 mm. Devices which have a diameter greater than necessary may, of course, be a potential source of trauma to the patient during their use. Devices of such small diameters would be highly desirable because they would allow access to sites deeper in the patient than those sites which can presently be accessed. Such small diameter devices would also be highly desirable because they would permit the treatment of smaller structures within the patient, for example, the expansion of smaller blood vessels than can currently be treated. Smaller diameter devices would also cause less trauma to the patient.
It would be highly advantageous to have medical devices which could readily and reliably be formed with uniform inner and outer diameters, particularly in micro-sizes at or below about 1 mm outer diameter. It would also be highly advantageous to have medical devices, particularly in micro-sizes, which resist collapse, necking and kinking during use. It would further be advantageous to have medical devices, again, particularly in micro-sizes, which possess good pushability, trackability and torquability in use. Finally, it would be advantageous to have such medical devices which enable access to sites deeper within patients than can generally be achieved with devices of conventional construction, and which presented a reduced possibility of trauma to the patient during their use.